Cutting Edge Microscopic Intraoperative Tissue Assessment for Guidance in Oncologic Surgery: A Systematic Review of the Role of Optical Coherence Tomography

Abstract

Introduction: There is a demand for intraoperative diagnostic support and image guidance in oncological surgery. Novel techniques can provide images similar to histopathological slides within a few minutes. Optical coherence tomography (OCT) and full-field OCT (FF-OCT) provide images with resolution greater than a hundred micrometers without the need for exogenous contrast agents or specimen staining. The aim of this systematic review was to assess the current clinical applications of OCT and dynamic cell imaging (DCI) in oncologic surgery, examining the translation challenges and proposing perspectives for improving future clinical applications.

Materials and methods: The study adhered to the PRISMA guidelines. PubMed, Google Scholar, and ClinicalTrials.gov were searched up to July 2024. Manuscripts reporting data on OCT and (D)-FF-OCT application in oncologic surgery were included in the qualitative analysis.

Results: Thirty-one studies met the inclusion criteria. Most were from the fields of dermatologic (25.8%) and breast cancer (29%) surgery, followed by prostate and bladder (9.6%), ovarian (9.6%), head and neck (6.4%), gastrointestinal (6.4%), hepato-biliary (3.2%), and general surgery (9.6%). The majority of articles focused on FF-OCT and DCI (80.6%). Compared with the gold standard of final pathology, the OCT sensitivity ranged between 66.7 and 94%, the specificity between 64 and 100%, and the accuracy between 73 and 96%.

Conclusions: The medical use of OCT has expanded from ophtalmology to other fields including gastroenterology and oncology and, with techniques such as FF-OCT and DCI, can enable rapid intraoperative diagnosis beyond classic histopathology.

Keywords: Artificial intelligence; FF-OCT; Image-guided surgery; Intraoperative real-time diagnosis; Laparoscopy; Minimally invasive surgery; Oncology; Real-time guidance; Robotic assisted surgery.